Denial Code 34 means that the insured has no coverage for newborns. Below you can find the description, common reasons for denial code 34, next steps, how to avoid it, and examples.
2. Description
Denial Code 34 is a Claim Adjustment Reason Code (CARC) and is described as ‘Insured has no coverage for newborns’. This denial code indicates that the insurance company will not provide coverage for newborns under the insured’s policy. This means that any claims submitted for services related to the care of a newborn will be denied.
2. Common Reasons
The most common reasons for denial code 34 are:
- Lack of Newborn Coverage: The insured’s policy does not include coverage for newborns. This could be due to specific policy exclusions or limitations that do not extend coverage to newborns.
- Missing Enrollment: The newborn may not have been properly enrolled in the insurance policy. If the insured did not add the newborn to their policy within the required timeframe, the insurance company may deny claims related to the newborn’s care.
- Incorrect Policy Information: Errors in the policy information submitted with the claim, such as incorrect policy numbers or outdated policy details, can result in denials under code 34. It is important to ensure that the correct policy information is provided when submitting claims for newborn care.
- Non-Compliant Coverage: Some insurance policies may require additional steps or documentation to activate coverage for newborns. Failure to comply with these requirements can lead to denials under code 34.
3. Next Steps
You can address denial code 34 as follows:
- Verify Newborn Coverage: Confirm whether the insured’s policy includes coverage for newborns. Review the policy documents or contact the insurance company to determine if newborn care is covered.
- Check Enrollment Status: Ensure that the newborn has been properly enrolled in the insurance policy. If not, follow the necessary steps to add the newborn to the policy within the required timeframe.
- Review Policy Information: Double-check the policy information submitted with the claim to ensure accuracy. Verify that the policy numbers and other details are correct and up to date.
- Comply with Additional Requirements: If the insurance policy has specific requirements for activating coverage for newborns, make sure to fulfill those requirements. This may involve submitting additional documentation or completing certain forms.
- Appeal or Seek Alternative Coverage: If the denial is incorrect or unjust, consider appealing the decision with the insurance company. Alternatively, explore other options for coverage, such as Medicaid or other government assistance programs that may provide coverage for newborn care.
4. How To Avoid It
To avoid denial code 34 in the future, consider the following steps:
- Review Policy Coverage: Before the birth of a child, carefully review the insurance policy to understand what coverage is provided for newborns. Be aware of any limitations or exclusions that may apply.
- Enroll Newborn Promptly: Ensure that the newborn is added to the insurance policy within the required timeframe. This may involve contacting the insurance company or employer to initiate the enrollment process.
- Provide Accurate Information: When submitting claims for newborn care, double-check that all policy information is accurate. This includes policy numbers, effective dates, and any other relevant details.
- Comply with Additional Requirements: If the insurance policy has specific requirements for activating coverage for newborns, make sure to fulfill those requirements promptly. This may involve submitting necessary documentation or completing any required forms.
- Explore Alternative Coverage Options: If the insured’s policy does not provide coverage for newborns or if there are limitations that may result in denials, consider exploring alternative coverage options such as Medicaid or other government assistance programs.
5. Example Cases
Below are two examples of denial code 34:
- Example 1: A claim is submitted for the medical services provided to a newborn baby. However, the insurance company denies the claim under code 34 because the insured’s policy explicitly excludes coverage for newborns.
- Example 2: The insured fails to enroll their newborn in the insurance policy within the required timeframe. As a result, any claims related to the newborn’s care are denied under code 34.
